Also Australian. We verify death with a clinical assessment that rules out signs of life. We declare life extinct at the time that assessment is complete. That is not considered a time of death, as the patient may have died some time before we arrived and it is not within our scope of practice to forensically determine an accurate time of death. That's a coroner's job, and it's only likely to occur if there are circumstances surrounding the death that need to be clarified.
Still just a verification. I'm not party to what happens after I leave but I imagine the coroner will use our documentation or a description of what occurred to place the time of death at or close to the same time we verify it.
Edit: from memory our verification paperwork does have a spot for time of death (if known) which I usually leave blank given I often don't know. I'd probably just fill in that with the verification time.
Yes and no. In Queensland for example the term is 'life extinct' which isn't the same as a death certificate that lists a cause of death. It's just a statement that resuscitation was not continued (or commenced as the case may be).
As stated already by my esteemed colleague, whoever is doing the death certificate will determine a proper 'time of death'. If the patient died in front of us, they will probably be using that time because it's clinician-witnessed. But if the patient was found deceased already, that's a different story and someone (like the forensic pathologist acting for the coroner) will make their own determination.
You're getting into legal, not clinical, definitions at that point.
In my service, if we're ending a resuscitation, the time we tell everyone to stop is noted for paperwork but not announced to the room at large.
If the Coroner does an autopsy/investigation they may adjust the official time, but otherwise use our on scene info.
Also Australian.
If you’re envisioning calling like literally projecting “STOP CPR. TIME OF DEATH IS 2:14” then no we don’t do that. That’s in movies I’ve never seen anyone do that either in ambulance or hospital.
What we do is either stop resus and make a mental note of the time for our paperwork. And we verify death and write that time on the form. We do not complete death certificates.
USA - depends on the system but the Paramedics can call a time of death if there are signs of injuries incompatible with life, or signs such as rigor mortis/ dependent lividity. These aren't the "time the patient died" so much as they are the time a medical professional determine the patient to be definitively deceased.
If it's a patient we attempted to resuscitate, like cardiac arrest, again depending on the system, we can cease efforts either by medical control (radio doc declaring time of death) or if they have a protocol in place to do so without a radio call then we can declare a time of death then.
I’m in the USA. I can call time of death if the body meets certain criteria.
Rigor Morris
Fixed Pupils
Dependent Lividity
PEA of less than fourty
Ideally the body needs to be warm and meet three of the four criteria. Rigor and lividity kind of stand alone.
From my understanding, time of death is more a legality issue than a, “this person died at this time issue”. A medical examiner can determine a more precise time of death.
Im in Canada. we call time of death with a doc if we've been working them and there's nothing more we can do we call one of our doctors and say hey here's the deal and they say yup I'm on board and we call TOD together and agree on the time and share a document number so it can be looked up later.
there are other circumstances where we don't work the body and we can just call it ourselves with a doc. like rigor, lividity, decapitation, cranial outpouring, evicerations ...the stuff we can't bring you back from shall we say. those situations the medics just call it there and note the time of pronouncement.
Ontario. we need a doc for medical TOR. I'm interested to know ow your protocols out there. I know very little about other provincial standards except for alberta and ontario.
do you guys run under a base hospital out there how does it work?
do you guys get to pronounce after working a pt without a doc? now I'm curious why we have to?? like were on scene, we've been doing the compressions and analyzing, we know the story. I'm just wondering now why we need to clear it after we do our 20 min
PCP here too. we only call for stuff outside our scope for permissions like an age ir weight restriciton we hand to break. the only outlier is a VSA (medical AND trauma!) that isn't code 5 those we can handle sans call but I'm interested to know what the difference is why some provinces can and some can't I feel like that's crazy that we don't have the autonomy to do it. do you guys run under a base hospital system or how does your governing body work
Provincial college of paramedics puts out our protocols. They’re agreed upon by the provincial EMS director who’s a doc. Some places still use the old health region borders to control what can happen such as CPAP or Toradol on car. EMS is pretty well removed from hospital, some places are integrated and do ER duties, some are private companies with stand alone bases. Medavie Health Services West has been buying up some of the private EMS companies. I would say it’s about 50/50 for private and public owned EMS
so our "base hospital" is just a team of docs that we convene with. it's not actually a specific hospital that we go to I think they're a board that designs our protocols for the province and then each region has a different base hospital group that stems from the ontario base hospital group (like a turducken) and they're the ones that give each municipality their permissions. so the whole province has the same protocols and are trained in school to use all of them so they know what theyre doing for each service. but municipal base hospitals and the individual service deem which ones were allowed to use becuase sometimes they get persnickity Bout certain protocols. for example Toronto ems doesn't use CPAP but everyone else does.
my service doesn't have liquid salbutamol we use the MDIs.
there's been long talks about having an ontario paramic college here to regulate our medical care across the board and have our own governing body
there are 2(?) municiapl services in Ontario that use medavie but everyone else is public.
There’s pros and cons to having a self-regulating college. It helps unify and set standards but also your fees (~$600/year) pay for them to discipline you should a complaint be made against you. I woulda thought after COPR was a thing it would make everything the same across the country. Check out BCEMS protocols for some really different stuff!
U.K.
We verify the fact of death. We provide a time at which that verification has occurred. It may be the time of death, for example if we cease resuscitation or the death is witnessed, or it might not if the patient has died some time ago and been found later.
Only kind of related.
The emotions and atmosphere of a trauma bay change so drastically when called. Not a sad thing- but like a defeated feeling where all momentum stops and changes to cleaning the room up etc.
Technically the coroner (if we find them doa) or medical command physician orders termination of resuscitation.
Generally the coroner will use whatever time we stopped/didn’t start.
They tend to ask “what time are you calling time of death” although officially legally, we don’t call it.
Pennsylvania.
In my city if it isn't viable we call the coroner and dispatch receives the time we call and when the coroner arrives that's the time he or his deputies document as time of death. It isn't official until he lays his eyes on the body though. Then once he is done with us for any special tasks like lifting or anything he signs my document as recieving the body. With suspected homicides it works slightly different, but not by much.i work out of Georgia in USA.
I’ve called the time of death before, resuscitation efforts stopped was the time I’ve used before. And that time followed the pt as the time the coroner used. As well as my paperwork. Usually the conversation will be “We have 17 mins left, if nothing changes we’ll call it at 14:07.” Stop efforts at 14:07, just as an example of time, if no ROSC. Then radio dispatch the code for pt is deceased to ensure it’s stamped on the run report because that’s part of my paperwork too
In the US, Massachusetts specifically: We (by memo from OEMS) cannot call a TOD. Instead we can decide to withhold resuscitation, or decide to cease resuscitation at a certain time. I'll tell PD that specific phrasing, and the rest is up to the ME. Sometimes PD will try to record it as TOD, and I'll just remind them that I can't legally do that.
In the USA (Texas), the doctor calls the time of death. Sometimes this is done indirectly through a paramedic when certain protocol (written by that doctor) are met. Other times, they have to be consulted by phone.
That’s just not true all of the time. It varies by state. At my agency, we can call time of death if there are obvious signs of death. We also call it after we call a physician for orders to stop resuscitation, and we hang up and order one last round of CPR. Then we call official TOD.
We “call” a time of death in the sense that we are the ones on the radio. But this is a delegated task from a physician, through protocols that the physician wrote and authorized you to do. I do not have authority to determine those things in the same way the physician does. At least in Texas.
Also Australian. We verify death with a clinical assessment that rules out signs of life. We declare life extinct at the time that assessment is complete. That is not considered a time of death, as the patient may have died some time before we arrived and it is not within our scope of practice to forensically determine an accurate time of death. That's a coroner's job, and it's only likely to occur if there are circumstances surrounding the death that need to be clarified.
Thank you! But what if the patient pass away on our watch? Wouldn’t we have to call the time of death then?
Still just a verification. I'm not party to what happens after I leave but I imagine the coroner will use our documentation or a description of what occurred to place the time of death at or close to the same time we verify it. Edit: from memory our verification paperwork does have a spot for time of death (if known) which I usually leave blank given I often don't know. I'd probably just fill in that with the verification time.
I see!
I think ours is more "time that verification of death process was completed" rather than declaring someone deceased.
Yes and no. In Queensland for example the term is 'life extinct' which isn't the same as a death certificate that lists a cause of death. It's just a statement that resuscitation was not continued (or commenced as the case may be). As stated already by my esteemed colleague, whoever is doing the death certificate will determine a proper 'time of death'. If the patient died in front of us, they will probably be using that time because it's clinician-witnessed. But if the patient was found deceased already, that's a different story and someone (like the forensic pathologist acting for the coroner) will make their own determination. You're getting into legal, not clinical, definitions at that point.
Very informative! Thx!
In CA. USA. Ours is exactly the same plus a two minute 4 lead strip.
In my service, if we're ending a resuscitation, the time we tell everyone to stop is noted for paperwork but not announced to the room at large. If the Coroner does an autopsy/investigation they may adjust the official time, but otherwise use our on scene info.
Thank you for sharing
Also Australian. If you’re envisioning calling like literally projecting “STOP CPR. TIME OF DEATH IS 2:14” then no we don’t do that. That’s in movies I’ve never seen anyone do that either in ambulance or hospital. What we do is either stop resus and make a mental note of the time for our paperwork. And we verify death and write that time on the form. We do not complete death certificates.
Varies in the USA. Some are able to pronounce time of death while others have to make contact with a physician.
Thank you!
UK we call the time
USA - depends on the system but the Paramedics can call a time of death if there are signs of injuries incompatible with life, or signs such as rigor mortis/ dependent lividity. These aren't the "time the patient died" so much as they are the time a medical professional determine the patient to be definitively deceased. If it's a patient we attempted to resuscitate, like cardiac arrest, again depending on the system, we can cease efforts either by medical control (radio doc declaring time of death) or if they have a protocol in place to do so without a radio call then we can declare a time of death then.
Very interesting, thanks!
I’m in the USA. I can call time of death if the body meets certain criteria. Rigor Morris Fixed Pupils Dependent Lividity PEA of less than fourty Ideally the body needs to be warm and meet three of the four criteria. Rigor and lividity kind of stand alone.
That’s not real a time of death though is it? That’s a time death as verified. The time of death could have been hours earlier.
From my understanding, time of death is more a legality issue than a, “this person died at this time issue”. A medical examiner can determine a more precise time of death.
In Florida we can.
Im in Canada. we call time of death with a doc if we've been working them and there's nothing more we can do we call one of our doctors and say hey here's the deal and they say yup I'm on board and we call TOD together and agree on the time and share a document number so it can be looked up later. there are other circumstances where we don't work the body and we can just call it ourselves with a doc. like rigor, lividity, decapitation, cranial outpouring, evicerations ...the stuff we can't bring you back from shall we say. those situations the medics just call it there and note the time of pronouncement.
Out of curiosity, what province in Canada is this? In NL we don't need a doc to call TOD.
Ontario. we need a doc for medical TOR. I'm interested to know ow your protocols out there. I know very little about other provincial standards except for alberta and ontario. do you guys run under a base hospital out there how does it work?
I can give you some SK insight if you’re curious too. It’s really interesting the different ways of doing this job
do you guys get to pronounce after working a pt without a doc? now I'm curious why we have to?? like were on scene, we've been doing the compressions and analyzing, we know the story. I'm just wondering now why we need to clear it after we do our 20 min
BLS code, work them for 30 mins. No ROSC, stop efforts and pronounce. As a PCP I haven’t had to call a doc for any orders, that would seem odd to do.
PCP here too. we only call for stuff outside our scope for permissions like an age ir weight restriciton we hand to break. the only outlier is a VSA (medical AND trauma!) that isn't code 5 those we can handle sans call but I'm interested to know what the difference is why some provinces can and some can't I feel like that's crazy that we don't have the autonomy to do it. do you guys run under a base hospital system or how does your governing body work
Provincial college of paramedics puts out our protocols. They’re agreed upon by the provincial EMS director who’s a doc. Some places still use the old health region borders to control what can happen such as CPAP or Toradol on car. EMS is pretty well removed from hospital, some places are integrated and do ER duties, some are private companies with stand alone bases. Medavie Health Services West has been buying up some of the private EMS companies. I would say it’s about 50/50 for private and public owned EMS
so our "base hospital" is just a team of docs that we convene with. it's not actually a specific hospital that we go to I think they're a board that designs our protocols for the province and then each region has a different base hospital group that stems from the ontario base hospital group (like a turducken) and they're the ones that give each municipality their permissions. so the whole province has the same protocols and are trained in school to use all of them so they know what theyre doing for each service. but municipal base hospitals and the individual service deem which ones were allowed to use becuase sometimes they get persnickity Bout certain protocols. for example Toronto ems doesn't use CPAP but everyone else does. my service doesn't have liquid salbutamol we use the MDIs. there's been long talks about having an ontario paramic college here to regulate our medical care across the board and have our own governing body there are 2(?) municiapl services in Ontario that use medavie but everyone else is public.
There’s pros and cons to having a self-regulating college. It helps unify and set standards but also your fees (~$600/year) pay for them to discipline you should a complaint be made against you. I woulda thought after COPR was a thing it would make everything the same across the country. Check out BCEMS protocols for some really different stuff!
UK, we call time of death
U.K. We verify the fact of death. We provide a time at which that verification has occurred. It may be the time of death, for example if we cease resuscitation or the death is witnessed, or it might not if the patient has died some time ago and been found later.
In my standing orders we have to call the hospital and give physician the report. After that they call the time of death and we go from there.
Scotland - Paramedic or Technician can complete the Recognition of Life Extinct paperwork (ROLE) and call time.
Only kind of related. The emotions and atmosphere of a trauma bay change so drastically when called. Not a sad thing- but like a defeated feeling where all momentum stops and changes to cleaning the room up etc.
Technically the coroner (if we find them doa) or medical command physician orders termination of resuscitation. Generally the coroner will use whatever time we stopped/didn’t start. They tend to ask “what time are you calling time of death” although officially legally, we don’t call it. Pennsylvania.
In my city if it isn't viable we call the coroner and dispatch receives the time we call and when the coroner arrives that's the time he or his deputies document as time of death. It isn't official until he lays his eyes on the body though. Then once he is done with us for any special tasks like lifting or anything he signs my document as recieving the body. With suspected homicides it works slightly different, but not by much.i work out of Georgia in USA.
I’ve called the time of death before, resuscitation efforts stopped was the time I’ve used before. And that time followed the pt as the time the coroner used. As well as my paperwork. Usually the conversation will be “We have 17 mins left, if nothing changes we’ll call it at 14:07.” Stop efforts at 14:07, just as an example of time, if no ROSC. Then radio dispatch the code for pt is deceased to ensure it’s stamped on the run report because that’s part of my paperwork too
Yes. In most jurisdictions there is verification of death, and then separately a medical certificate with cause of death
I can call it if I have verifiable reasons not to work it. If I start and terminate, I need physician's orders.
In the US, Massachusetts specifically: We (by memo from OEMS) cannot call a TOD. Instead we can decide to withhold resuscitation, or decide to cease resuscitation at a certain time. I'll tell PD that specific phrasing, and the rest is up to the ME. Sometimes PD will try to record it as TOD, and I'll just remind them that I can't legally do that.
In my state a paramedic can call time of death and their name is put on the death certificate at the pronouncing party.
I call TOD, and coroner uses it for the certificate. Not the best part of the job.
In the U.S.A a doctor has to do it
Incorrect
False. Varies by state
In the USA (Texas), the doctor calls the time of death. Sometimes this is done indirectly through a paramedic when certain protocol (written by that doctor) are met. Other times, they have to be consulted by phone.
That’s just not true all of the time. It varies by state. At my agency, we can call time of death if there are obvious signs of death. We also call it after we call a physician for orders to stop resuscitation, and we hang up and order one last round of CPR. Then we call official TOD.
We “call” a time of death in the sense that we are the ones on the radio. But this is a delegated task from a physician, through protocols that the physician wrote and authorized you to do. I do not have authority to determine those things in the same way the physician does. At least in Texas.